Revista de Osteoporosis y Metabolismo Mineral

Association of gamma glutamyl transferase in the presence and progression of abdominal aortic calcifications and changes to bone mineral density

Resumen Introducción y objetivo: la calcificación aórtica abdominal (CAA) es predictora de eventos cardiovasculares. El objetivo de este trabajo fue valorar la asociación de la gamma glutamil transferasa (GGT) con presencia y progresión de CAA y los cambios en densidad mineral ósea (DMO) en columna lumbar y cuello femoral. Material y métodos: se seleccionaron 326 hombres y mujeres mayores de 50 años que realizaron un cuestionario, dos radiografías laterales dorso-lumbares y DMO, repitiendo a los 4 años las mismas pruebas y un estudio analítico. Resultados: la presencia y progresión de CAA (nuevas o mayor severidad) fue inferior en el cuartil 1 (Q1) de GGT respecto a los otros cuartiles (40 % vs. 58 %, p = 0,021; 24 % vs. 44 %, p = 0,022). Comparado con Q1, el análisis de regresión logística ajustado por confusores mostró que los Q2 y Q4 se asociaron con aumentos en la presencia de CAA [odds ratio (OR) = 2,53, intervalo de confianza del 95 % (IC 96 %) = (1,22-5,25) y OR = 3,04, IC 95 % = (1,36-6,77)] y Q2, Q3 y Q4 se asociaron con aumentos en progresión de CAA [OR = 2,24, IC 95 % = (1,07-4,67); OR = 2,35, IC 95 % = (1,09-5,07) y OR = 3,47, IC 95 % = (1,56-7,70)]. El análisis multivariante por sexos mostró que tanto en hombres como mujeres el Q4 de GGT se asoció con progresión de CAA [OR = 3,27, IC 95 % = (1,14-9,36) y OR = 3,26, IC 95 % = (1,03-10,29) respectivamente] y en mujeres con mayores pérdidas de DMO a nivel lumbar. No hubo efecto con respecto a la prevalencia de CAA. Conclusiones: valores elevados de GGT podrían ser un indicador de presencia y progresión de CAA en población mayor de 50 años. De forma separada por sexo, los mayores niveles de GGT se asociaron con progresión de CAA, siendo un marcador pronóstico de daño cardiovascular.

Abstract Introduction and objective: abdominal aortic calcification (AAC) is a predictor of cardiovascular events. This study aimed to assess the association of gamma glutamyl transferase (GGT) in the presence and progression of AAC, as well as changes to bone mineral density (BMD) in the lumbar spine and femoral neck. Materials and methods: a total of 326 men and women over 50 years of age were selected for this study. They completed a questionnaire, underwent two lateral dorso-lumbar spine X-rays, and BMD measurements. The same tests and 1 analytical assessment were repeated after 4 years. Results: the presence and progression of AAC (new occurrences or increased severity) were lower in GGT quartile 1 (Q1) compared with the other quartiles (40 % vs 58 %; p = 0.021; 24 % vs 44 %; p = 0.022). Compared with Q1, the confounders-adjusted logistic regression analysis showed that Q2 and Q4 were associated with more presence of AAC [odds ratio (OR), 2.53; 95 % confidence interval (95 % CI), 1.22-5.25 and OR, 3.04; 95 % CI, 1.36-6.77]. Additionally, Q2, Q3, and Q4 were associated with more AAC progression [OR, 2.24; 95 % CI, 1.07-4.67; OR, 2.35; 95 % CI, 1.09-5.07; and OR, 3.47; 95 % CI, 1.56-7.70]. The gender-stratified multivariate analysis revealed that in both men and women, the Q4 of GGT was associated with AAC progression [OR, 3.27; 95 % CI, 1.14-9.36, and OR, 3.26; 95 % CI, 1.03-10.29, respectively], and in women alone, with greater lumbar BMD losses. There were no effects regarding the prevalence of AAC. Conclusions: elevated GGT levels could serve as an indicator of the presence and progression of AAC in individuals older than 50 years. When analyzed separately by gender, higher GGT levels were associated with AAC progression, which acted as a prognostic marker for cardiovascular disease.

Should the FRAX tool include other variables to assess fragility-related osteoporotic fractures?

Resumen Introducción y objetivo: el objetivo fue valorar la relevancia de variables no contenidas en el FRAX sobre la incidencia de fractura osteoporótica. Material y métodos: participaron 316 mujeres > 50 años seguidas 8 años. Se evaluaron variables que recoge FRAX (edad, IMC, fractura previa, antecedentes parentales de fractura de cadera, hábito tabáquico, glucocorticoides, DMO cuello femoral) y que no recoge (edad de menarquia, menopausia, años fértiles y nuliparidad). Resultados: edad y antecedentes parentales de fractura de cadera se asociaron con fractura de cadera, pero también edad de menopausia y años fértiles. La edad [odds ratio (OR) = 1,09, Intervalo de confianza del 95 % (IC 95 %) = (1,01-1,17)] y edad de menopausia [OR = 0,90, IC 95 % = (0,82-0,99)] se asociaron con fractura de cadera tras análisis multivariante ajustado por edad e IMC. IMC, DMO en cuello femoral y nuliparidad se asociaron con fractura de Colles. En el análisis multivariante, solo nuliparidad se asoció con fractura de Colles [OR = 4,59, IC 95 % = (1,59-13,26)]. La fractura mayor osteoporótica se asoció significativamente con antecedentes parentales de fractura de cadera, nuliparidad y años fértiles. En el análisis multivariante, antecedentes parentales de fractura de cadera [OR = 3,26, IC 95 % = (1,23-8,61)], nuliparidad [OR = 3,07; IC 95 % = (1,48-6,37)] y años fértiles [OR = 0,92, IC 95 % = (0,87-0,98)] se asociaron con fractura mayor osteoporótica. Conclusiones: de las variables del FRAX, edad y antecedentes parentales de fractura de cadera se asociaron con incidencia de fractura mayor osteoporótica y de cadera, pero otras variables ginecológicas tuvieron un peso similar, lo que sugiere que deben ser tenidas muy en cuenta a la hora de realizar la anamnesis de las pacientes.

Abstract Introduction and objective: the objective of this study was to assess the significance of variables not included in the FRAX tool regarding the incidence of osteoporotic fractures. Materials and methods: a total of 316 women older than 50 years were followed for 8 years. The variables collected (age, BMI, previous fracture, parental history of hip fracture, smoking habit, use of glucocorticoids, femoral neck BMD) and those not collected by the FRAX tool (age at menarche, menopause, fertile years, nulliparity) were studied. Results: age and parental history of hip fracture were associated with hip fractures, but so were age at menopause and fertile years. Age [odds ratio (OR), 1.09; 95 % confidence interval (CI), 1.01-1.17] and age at menopause [OR, 0.90; 95 %CI, 0.82-0.99] were associated with hip fractures after the multivariate analysis adjusted for age and BMI. BMI, femoral neck BMD and nulliparity were associated with the occurrence of Colles fractures. According to the multivariate analysis, only nulliparity was associated with Colles fractures [OR, 4.59; 95 %CI, 1.59-13.26)]. Major osteoporotic fractures were significantly associated with parental history of hip fracture, nulliparity, and fertile years. According to the multivariate analysis, the parental history of hip fracture [OR, 3.26; 95 %CI, 1.23-8.61], nulliparity [OR, 3.07; 95 %CI, 1.48-6.37], and fertile years [OR, 0.92; 95 %CI, 0.87-0.98] were associated with the occurrence of major osteoporotic fractures. Conclusions: among the FRAX variables, age and parental history of hip fracture were associated with the incidence of major osteoporotic and hip fractures. However, the significance of other gynecological variables was similar, which is indicative that they should certainlay be taken into consideration during patient history assessment.

Efficacy of an oral collagen therapy compared with intra-articular therapies (hyaluronic acid and platelet-rich plasma) to treat knee osteoarthritis

Abstract Introduction: osteoarthritis is a chronic and progressive disease. It affects over 30 % of people older than 60. Osteoarthritis is currently recognized as a multifactorial disease. Various conservative treatments are used in the management of knee osteoarthritis (NSAIDs, analgesics, and intra-articular therapy). We conducted a randomized clinical trial to determine if a 10 g therapy of hydrolyzed collagen along with 100 mg fucoidan (Hydroidan pro, Acten, Switzerland) is more effective than intra-articular therapies. Methods: we divided patients into 3 groups. The first group received 23 g of ACTEN®, daily, for 3 months. The other groups received a single intra-articular injection of hyaluronic acid (5 ml) or platelet-rich plasma (3 ml). We used the WOMAC scale, the SF-12 scale, and the VAS for pain at baseline, and 4, 12, and 24 weeks later. Results: we enrolled 108 patients with grade II-III knee osteoarthritis who underwent a 24-week follow-up study. The mean age was 57 years (53-65). The three groups showed low scores in the WOMAC group (p < 0.001). The collagen with fucoidan group had lower WOMAC and VAS scores compared with the hyaluronic acid and platelet-rich plasma groups at 24 weeks (p < 0.001). Conclusions: collagen along with fucoidan taken orally, daily, for 12 weeks seem to have better results in the WOMAC and VAS scales compared with intra-articular therapies such as hyaluronic acid or platelet-rich plasma. Combined oral and intra-articular therapies should be tried to determine their efficacy profile.

Cellular senescence as a pathogenic factor and potential therapeutic target in osteoporosis

Resumen La senescencia celular es un proceso inducido por varios tipos de estrés que causan una detención irreversible del ciclo celular y un cambio en las características y la funcionalidad de las células, además de la adquisición de un fenotipo secretor que genera un ambiente proinflamatorio. Si bien en determinados contextos es beneficiosa para los tejidos y promueve el desarrollo del organismo, la senescencia es un destino celular implicado en el proceso de envejecimiento y en las patologías degenerativas relacionadas con la edad. Los senolíticos son fármacos que eliminan específicamente a las células senescentes y los senomórficos son fármacos que suprimen su fenotipo secretor asociado a senescencia (SASP) sin inducir la muerte celular. Así, las estrategias terapéuticas enfocadas en las células senescentes (senolíticos y senomórficos) como mecanismo subyacente al envejecimiento, se erigen en una alternativa con gran potencial para luchar contra las enfermedades relacionadas con la edad en su conjunto, y no de forma individual. Una de estas patologías es la osteoporosis, donde además se han descrito, a nivel experimental, que fármacos como el ácido zoledrónico tiene efecto sobre los preosteoblastos y actúa sobre las células senescentes, prolongando la supervivencia y abriendo la puerta a la posibilidad de tratar las enfermedades relacionadas con la edad con fármacos que ya se empleen en la práctica, y que puedan tener un efecto más allá del propio hueso y aumentar la supervivencia. En este trabajo se va a realizar una revisión en este campo de vertiginoso crecimiento en los últimos años y con indudable interés traslacional.

Abstract Cellular senescence is a process induced by various types of stress that irreversibly cause cell cycle arrest and changes to the characteristics and functionality of cells, as well as the acquisition of a secretory phenotype that generates a pro-inflammatory environment. While, in certain contexts, it is beneficial for tissues and promotes organism development, senescence is a cellular fate implicated in the process of aging and age-related degenerative conditions. Senolytics are drugs that specifically eliminate senescent cells, and senomorphics are drugs that suppress their senescence-associated secretory phenotype (SASP) without inducing cell death. Therefore, therapeutic strategies targeting senescent cells (senolytics and senomorphics) as an underlying mechanism of aging emerge as an alternative with great potential to fight age-related diseases as a whole rather than individually. One of these conditions is osteoporosis where it has been experimentally described that drugs such as zoledronic acid have effects on preosteoblasts and act on senescent cells extending survival and opening up the possibility of treating age-related diseases with drugs already used in practice, which may have effects beyond the bone itself and increase overall survival. In this study, a review will be conducted in this rapidly growing field in recent years of undeniable translational interest.

Heterotopic ossification after hip arthroplasty: role of bone SPECT/CT scintigraphy

Resumen La osificación heterotópica es una condición limitante, que afecta predominantemente a la cadera. Dada su relación con patología postraumática/posquirúrgica, la gammagrafía ósea SPECT/TC resulta de especial utilidad en el diagnóstico diferencial con movilización protésica, aun cuando no hay alteraciones radiológicas. Además, resulta ser una herramienta eficaz para planificación quirúrgica atendiendo al grado de maduración ósea y la posibilidad de fabricar biomodelos mediante impresión 3D.

Abstract Heterotopic ossification is a limiting condition that predominantly affects the hip. Because of its association with post-traumatic/postoperative pathology, bone SPECT/CT scintigraphy has proven to be especially useful regarding differential diagnosis involving prosthetic mobilization, even in the absence of radiological abnormalities. Additionally, it is an effective tool for surgical planning, considering the degree of bone maturation and the possibility of creating biomodels using 3D printing.

Refining the categorization of osteoporotic fracture risk